Download Understanding Treatment Options for Renal Therapy

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Understanding Treatment Options for Renal Therapy
Kidney failure happens
to many different people
for many different reasons
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What causes kidney failure?
Diabetes
■ High blood pressure
■ Glomerulonephritis
■ Polycystic kidneys
■
Chronic infection
■ Heredity
■ Other
■
How do you treat patients with
kidney failure?
Diet/fluid restrictions
■ Medication
■ Kidney Dialysis
■ Kidney transplantation
■ Non-treatment
■
Take care of yourself!
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Why is diet important?
Most waste and excess
fluid comes from the food
you eat
■ As kidney function
declines, less waste is
filtered out of your blood
■ Waste and fluid build-up
can make you ill
■ Diet can help control the
problems caused by
kidney disease
■
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Main parts of the diet for kidney disease
■
■
■
Protein
Calcium/Phosphorus
Potassium
■
■
■
Fluid
Sodium
Calories
How do you know if your diet is working?
■
■
■
■
Weight loss or gain
Swelling of hands and feet
Blood pressure
Blood tests
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Know your numbers
Blood/Urine Test
Your Value Normal for You
Serum Creatinine
Creatinine Clearance
(24 hour urine)
BUN
(Blood Urea Nitrogen)
Potassium (K+)
Phosphorus
Calcium
Albumin
Hematocrit/Hemoglobin
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What do the kidneys do?
Clean the blood
Remove extra fluid
Filter out waste
products
Keep your body
chemicals in balance
Control blood
pressure and red
blood cells
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What is anemia?
■
A low red blood cell and oxygen level that is
common in patients with kidney disease
Symptoms
Feeling tired
Constantly feeling
cold
■ Shortness of breath
■ Feeling dizzy
■
■
Rapid, irregular heart
beat
■ Impotence
■ Trouble concentrating
■
How is anemia of kidney disease treated?
■
■
■
Epogen
Iron supplements
Measurements of
Hematocrit/Hemoglobin
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What is uremia?
■
The result of a build-up of waste products
that damaged kidneys don’t filter out of the
bloodstream very well
Symptoms
■
■
■
Loss of appetite
Headache
Bad taste in your
mouth
■
■
■
Trouble concentrating
Nausea/vomiting
Drowsiness
As kidney function
decreases, uremic
symptoms will worsen.
Dialysis can relieve many
of these symptoms
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You need to take
an active role in
your own care
and in helping to
choose which
treatment option
is best for you.
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Treatment options
Kidney dialysis
A way to remove waste products and excess
fluid from your blood. The two forms of kidney
dialysis treatments are:
■ Hemodialysis
■ Peritoneal dialysis
Kidney transplantation
An operation which places a healthy kidney
into your body.
Non-treatment
While an option, the non-treatment choice
could eventually lead to death.
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What is hemodialysis?
The word “hemo” refers
to blood. Hemodialysis is
a process which balances
blood chemistry
(electrolytes) and filters
wastes and fluids from
the blood.
The blood travels outside
the body through tubing
and passes through a
filter on a dialysis
machine. The filter
cleans the blood. The
clean blood is returned
to your body.
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What happens during hemodialysis?
Dialysis
Machine
Dialyzer
Blood to
Dialyzer
Blood Back to Body
The dialysis machine pumps the blood
through the filter - called a dialyzer.
Two needles are inserted into a
permanent access, usually in your arm
for each hemodialysis treatment. One
withdraws the blood; the other needle
returns the filtered blood to your body.
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How is blood removed and replaced?
From machine
To machine
Artery
A “fistula” is the surgical
linking of an artery to a vein
providing permanent access to
blood vessels.
Vein
Artery
Graft
Vein
A “graft” is tubing surgically
placed under the skin, linking
an artery to a vein. The
"graft" is another type of
permanent access to blood
vessels.
Another type of access used for hemodialysis is called a
central venous access. A small soft tube called a catheter is
placed into a large vein in the neck or shoulder or groin areas
allowing access or entry to the blood stream. This type of
access is usually temporary.
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In-Center Hemodialysis
Advantages
Disadvantages
■ trained professionals
perform treatment for you
■ maintain regular contact
with other hemodialysis
patients and staff
■ 3 treatments per week;
4 days off
■ keep no
equipment/supplies at
home
■ medical help is available
quickly in an emergency
■ travel to center 3 times a
week on a fixed schedule
■ need a permanent access,
usually in your arm
■ insert 2 needles for each
treatment
■ restricted diet/limited fluid
intake
■ possible discomfort like
headache, nausea, leg
cramps, tiredness
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Home Hemodialysis
Advantages
Disadvantages
■ same person always helps
you
■ more control over when
you dialyze
■ no travel to a clinic
■ must have a trained partner
to help you
■ you need to be trained
■ need room to store
equipment/supplies
■ need to call paramedics for
help in an emergency
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What is peritoneal dialysis?
Just like in hemodialysis,
peritoneal dialysis (PD) uses
a filter to clean the blood
and remove excess fluids.
With PD, the blood is
cleansed inside the body
using one of the body's
own membranes, the
peritoneum, as the filter.
PD is performed primarily
as a home therapy.
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How does peritoneal dialysis work?
PD uses your
peritoneal membrane the lining of your
abdomen - as the filter.
Solution is placed in the
abdomen in contact with
the peritoneal membrane
for several hours. Wastes
and fluids pass through
the peritoneal membrane
or filter into the solution.
Later, the solution and
waste are drained from
your abdomen.
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Peritoneal dialysis catheter
For PD, a tube called a catheter is surgically
placed trough the wall of your abdomen. It
is your permanent access for PD.
■ The catheter is usually placed about an
inch below and to the side of the navel.
■ About 2-4" of the catheter extends out of
the body.
■ The catheter is usually used 10-14 days
after placement for the initiation of
Peritoneal Dialysis therapy.
■
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There are two kinds of peritoneal dialysis
■
Continuous Ambulatory
Peritoneal Dialysis (CAPD)
A manual method performed
by you usually 4 times
throughout the day.
■
Automated Peritoneal
Dialysis (APD)
An automated method of
PD, performed by a machine
primarily at night while you
sleep.
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How do I perform a CAPD treatment?
CONNECT
FILL
DRAIN
DISCONNECT/DWELL
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Where can I perform a CAPD exchange?
You can do CAPD in any clean area at home,
at work, at school or even on vacation.
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How do I perform an APD treatment?
You attach the tubing
and solution bags to the
machine. Before going to
sleep, you connect the
tubing to the peritoneal
catheter. During the
night the machine
performs dialysis. For
extra therapy, dialysis
solution remains in the
peritoneal cavity during
the day. The peritoneal
cavity of most adults can
hold about two to three
quarts of fluid.
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Peritoneal Dialysis
Advantages
Disadvantages
■ a flexible lifestyle and
independence
■ few diet restrictions
■ usually visit clinic just once a
month
■ doesn’t use needles
■ gives better blood pressure
control
■ is continuous therapy which is
gentler and more like your
natural kidneys
■ don’t have to travel to dialysis
unit for treatment
■ easy to take your therapy with
you when you travel
■ therapy occurs while you sleep
(APD)
■ need to schedule exchanges
into your daily routine, 7 days
a week
■ have a permanent, external
catheter
■ run some risk of infection
■ may gain weight/have a larger
waistline
■ very large people may need
extra exchanges
■ need storage space in your
home for supplies
■ need space in your bedroom
for equipment (APD)
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What is kidney transplantation?
A kidney transplant is an
operation in which a
healthy kidney from
another person is placed
into your body. This new
kidney performs the
functions of your own
non-working kidneys.
Dialysis will probably be
required will awaiting
your transplant.
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Sources of transplanted kidneys
Living Donors
family members make
the closest tissue
matches.
Cadaver Donors
from people who decide
to donate their organs
when they die.
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Where is the new kidney located?
During the operation, a
healthy kidney is placed
deep under the muscle
of the abdomen near
your hipbone.
In rare cases, the
non-working kidneys
may be removed to
control infection or high
blood pressure.
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How do you take care of a
transplanted kidney?
Take your medicine every day
■ Visit regularly with your physician
■ Follow your physician's guidelines
■ Control your diet
■ Keep yourself active
■ Watch for problems
■
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Transplantation
Advantages
Disadvantages
■ feels closest to having your
own kidneys
■ no dialysis treatments
required
■ lets you maintain a normal
schedule and visit a clinic
less often
■ fewer fluid and diet
restrictions
■ feel healthier and have
more energy
■ work full-time without
worrying about any dialysis
schedule
■ the stress of waiting for a
match
■ risks associated with major
surgery
■ risk of rejection — your
transplant may not last a
lifetime
■ take medications every day
— which can have side
effects
■ you are more susceptible to
illness
■ possible changes in your
appearance
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Who pays for treatment?
For most people in the U.S.,
treatment is paid for by
Medicare, private insurance,
health maintenance
organizations (HMOs), state
medical assistance programs,
state renal programs and
supplemental local programs.
Ask your social worker about
which programs apply to you.
Or, contact any of the patient
associations listed in the back
of this flipchart.
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Commonly asked questions
1 Will dialysis cure me?
2 What if I decide I don't like my treatment
choice - can I change?
3 When I am a dialysis patient, are there
activities that I'll no longer be able to do?
4 Can I still work while on dialysis?
5 Will I feel good all the time?
6 What effect will my general health or visual
or manual impairment have on my choice
of treatment?
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How do I select which treatment
is best for me?
Learn the facts about each treatment option.
■ Discuss each option with your renal health-care
team - your doctor, nurse, nutritionist or
dietician, and other medical team members - to
determine which option(s) best suits your
medical requirements.
■ Discuss each option with your family, and
review which option best fits your lifestyle.
■ It is quite common for patients to change
treatments. You can have several methods of
treatment throughout your life. Patients may
change from one treatment to another as their
health or needs change.
■
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You are the most important member
of your renal care team
■
You are not alone - many
other people have kidney
disease and have learned to
live happy, active productive
lives.
■
By understanding your
condition and the important
role you play in your
treatment, you have taken
the first step towards a
healthier life.
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To learn more… ask your doctor and renal care
team members for information about dialysis.
You can also contact such groups as:
American Association of Kidney Patients (AAKP)
1-800-749-2257
http://www.aakp.org
This patient membership group provides education and support
programs for the kidney patient.
American Kidney Foundation (AKF)
1-800-638-8229
http://www.akfinc.org
This group serves as a financial resource for kidney dialysis and transplant patients who need help.
National Kidney Foundation (NKF)
1-800-622-9010
http://www.kidney.org
This national voluntary health agency is dedicated to wiping out
kidney and urological disease, and providing programs and services to
patients and their families.
Your Social Security office has people who can help as well.
Call 1-800-772-1213 to find the nearest Social Security office.
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To learn more about staying healthy
with kidney disease, enroll now in
Stay in Touch, a free kidney
education program.
■ Call 1-877-543-6394 to enroll by phone
■ Go to www.kidneydirections.com to
enroll via the internet
■ Ask your physician or healthcare team to
enroll you
© 2002 Baxter Healthcare Corporation 5L 0328 11/02.
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